| NPI | 1568420982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0001X Internal Medicine Clinical & Laboratory Immunology (Licence: WV 51076) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: WV 51076) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2009-02-24 |