| NPI | 1255588679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60044488) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC 137595) |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2022-07-22 |