| NPI | 1093112484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61348329) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME MD21548) |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2024-01-02 |