| NPI | 1487611430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD438998) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA052282) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2011-07-11 |