| NPI | 1275716060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60797274) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO Pending) |
| Enumeration Date | 2007-12-14 |
| Last Update Date | 2019-12-13 |