| NPI | 1063902542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP61247136) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 010927) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2024-08-08 |