| NPI | 1649633041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60943416) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID M14693) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2019-05-31 |