| NPI | 1033746318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP61453386) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM DO2022-0144) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2025-11-11 |