| NPI | 1356799290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP61323112) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MB10544400) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2022-07-27 |