| NPI | 1639142508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY TL2282) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SD 4231) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2021-05-11 |