| NPI | 1639127228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60739929) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 20209) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2021-05-10 |