| NPI | 1992135990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60951980) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 304065) |
| Enumeration Date | 2013-11-13 |
| Last Update Date | 2021-04-28 |