| NPI | 1801821913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM 90-172) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00047511) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2019-10-14 |