| NPI | 1417397340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 61493897) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 255884) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2025-05-19 |