| NPI | 1851734560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 72501) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60950169) |
| 207R00000X Internal Medicine (Licence: WA MD60950169) | |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2022-10-14 |