| NPI | 1316432289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY TL6697) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2018020770) |
| Enumeration Date | 2018-06-24 |
| Last Update Date | 2022-11-04 |