| NPI | 1851377303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00020389) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 23571) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2021-03-16 |