| NPI | 1881074656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61006154) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2015014346) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2020-10-19 |