| NPI | 1851704563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60849538) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD462381) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2025-05-22 |