| NPI | 1619462520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 61193782) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.073152) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2022-11-09 |