| NPI | 1144782210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: WA OP61576180) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125074045) |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2024-08-06 |