| NPI | 1225124795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 27997) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID M-6364) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2022-11-01 |