| NPI | 1619111903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 60562817) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR 173010) |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2022-02-04 |