| NPI | 1114381084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP60942877) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR PG177714) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2019-06-04 |