| NPI | 1528175973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 14817) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA 24876) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2013-09-06 |