| NPI | 1679587372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME73810) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61235321) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2022-10-18 |