| NPI | 1558473256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 0044779) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61273322) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-04-28 |