| NPI | 1417485657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV DO3236) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA OP61049544) |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2022-12-28 |