| NPI | 1215461801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 323820) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61505715) |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2024-02-01 |