| NPI | 1144607011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60815256) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN21403) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2021-05-20 |