| NPI | 1063953099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP70094288) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101027280) |
| Enumeration Date | 2017-03-09 |
| Last Update Date | 2026-09-03 |