| NPI | 1851533137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60573974) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD156632) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2023-10-09 |