| NPI | 1043870009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61331507) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2019018426) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2022-09-10 |