| NPI | 1174025647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 61227551) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 32212) |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2022-11-22 |