| NPI | 1477752723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP60390831) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 500) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2024-04-25 |