| NPI | 1386987030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 60666892) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD176800) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2022-07-21 |