| NPI | 1104320043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME148538) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA 1104320043) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2026-08-03 |