| NPI | 1689950529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60672249) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.132396) |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2024-06-12 |