| NPI | 1366409500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60247710) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 24499) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2021-04-05 |