| NPI | 1871583716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 26602) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI MD10162) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: HI MD10162) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: WV 26602) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2020-05-21 |