| NPI | 1063778587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD.MD.61535193) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 284098) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2024-05-10 |