NPI | 1265428395 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 65301) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00042042) |
Enumeration Date | 2005-09-23 |
Last Update Date | 2022-04-01 |