NPI | 1871088229 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP61616183) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101024222) |
207R00000X Internal Medicine (Licence: OR DO211989) | |
Enumeration Date | 2018-06-28 |
Last Update Date | 2025-09-08 |