| NPI | 1114990538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60593879) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 11074) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2023-07-13 |