| NPI | 1780668350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 13203A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 9969) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2021-02-18 |