| NPI | 1346213238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60390116) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 19404) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2021-03-25 |