| NPI | 1760434740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP60662799) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT 10364) |
| 207R00000X Internal Medicine (Licence: ID O-1460) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2023-05-23 |