| NPI | 1902268238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 61395632) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID M-14830) |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2023-06-22 |