| NPI | 1750907143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0116034298) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA OP61432898) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2023-07-19 |