| NPI | 1053802439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP61628433) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS17834) |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2025-02-26 |