| NPI | 1902961907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD13265) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00034537) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2024-03-25 |