| NPI | 1316979644 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00020233) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID M-4552) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-07-07 |