| NPI | 1679680383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME134012) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA 29838) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2023-05-22 |