| NPI | 1144644345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP60935579) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 1558) |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2019-10-11 |