| NPI | 1619403417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61004077) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R76254) |
| 207R00000X Internal Medicine (Licence: AZ 57108) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2020-09-21 |