| NPI | 1992782288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60212080) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 21316) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2021-01-05 |