Overview
Name:
Specialty:
Type of Practice:
Provider/Org:
Medical School: OTHER
Graduation year from medical school: 1982
Affiliation:
Specialties
Practice Type:
Classification:
Specialization: . INTERNAL MEDICINE
Definition of Specialty:
License & NPI
License #(s): , , , ,
License State(s): , , , ,
Addresses
Practice Location:
Mailing Address:
Contact #
Practice location phone #:
Practice location fax #:
Mailing address Phone #:
Mailing Address fax #:
Authorized official Name/Telephone #:
Misc
Date NPI was obtained:
Last data data was updated:
Insurances: