| NPI | 1376571620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 00037227) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA 00037227) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2024-04-12 |