| NPI | 1063432292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00038259) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID M-13967) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2021-08-31 |