| NPI | 1669451936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS19595) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA OP61126211) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2023-03-17 |