| NPI | 1235753864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61357913) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351046792) |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2023-07-18 |