| NPI | 1396735346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD27040) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 4217A) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2007-12-06 |