| NPI | 1356404990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60133766) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD432456) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2021-05-19 |