| NPI | 1164536728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00022728) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID M4849) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2024-06-04 |