| NPI | 1558579946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP60764910) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS015253) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2022-07-21 |