| NPI | 1487077566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61486738) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 66833) |
| Enumeration Date | 2014-01-27 |
| Last Update Date | 2024-05-31 |