| NPI | 1578128658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61401126) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 63952) |
| Enumeration Date | 2019-05-05 |
| Last Update Date | 2023-05-02 |