| NPI | 1053329490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M5447) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00032566) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2021-03-11 |