| NPI | 1295799906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-133007) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00045355) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2022-11-18 |