| NPI | 1902033038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD.60272450) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2009010334) |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2021-04-15 |