| NPI | 1891178521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 1891178521) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 42776) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2021-07-19 |