| NPI | 1750671061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 20875) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60481616) |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2021-07-13 |