| NPI | 1972545143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID MC-1136) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00028087) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2024-07-24 |