| NPI | 1831540723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61352375) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 267668) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2023-12-29 |