| NPI | 1952408205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP60069825) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS005995L) |
| 207R00000X Internal Medicine (Licence: MS 11139) | |
| 207R00000X Internal Medicine (Licence: VA 0102050068) | |
| 207R00000X Internal Medicine (Licence: WA OP60068825) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2022-03-16 |