| NPI | 1528142734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60656543) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI MD12518) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2020-05-14 |