| NPI | 1427226034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 8096A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2007020221) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2015-07-17 |