| NPI | 1356623177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD182876) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60552601) |
| Enumeration Date | 2011-09-16 |
| Last Update Date | 2022-02-10 |