| NPI | 1356761985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP60962822) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME DO2809) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2024-12-13 |