| NPI | 1124065792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT 13625) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA OP60225814) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2023-07-10 |