| NPI | 1396008306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 26561) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL34918) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2015-09-11 |