| NPI | 1629357744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60425608) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA 60425608) |
| Enumeration Date | 2011-08-07 |
| Last Update Date | 2020-12-04 |