| NPI | 1023060126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD14134) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD38224) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2020-01-07 |