| NPI | 1164628756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60205862) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI MDR-5279) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2020-10-26 |