| NPI | 1720540784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61258906) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID MRM1804) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2023-05-03 |