| NPI | 1497084842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60579714) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125052227) |
| Enumeration Date | 2009-12-14 |
| Last Update Date | 2020-12-04 |