| NPI | 1154689420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61568690) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01086406A) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2024-08-06 |