| NPI | 1821065004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 9861) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 11208) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2016-05-26 |