| NPI | 1417048893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60091837) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 41518) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2024-12-19 |