| NPI | 1477781102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 54735-20) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301094403) |
| 208D00000X General Practice (Licence: WI 54735-20) | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2014-07-10 |