| NPI | 1598128670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61309720) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 301785) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2022-08-01 |