| NPI | 1093952582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60663211) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 51796) |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2017-03-15 |