| NPI | 1417290891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60853634) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 054997) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2021-03-30 |