| NPI | 1265762678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60274004) |
| Additional Taxonomies | 174400000X Specialist |
| 204R00000X Electrodiagnostic Medicine (Licence: FL ME114033) | |
| 207R00000X Internal Medicine (Licence: FL ME114033) | |
| Enumeration Date | 2010-01-07 |
| Last Update Date | 2020-12-08 |