| 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 |