| NPI | 1760613921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD155659) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60210092) |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2020-11-10 |