| NPI | 1144336140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00044049) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-1306) |
| 207Q00000X Family Medicine (Licence: OR MD25034) | |
| 207Q00000X Family Medicine (Licence: WA MD00044049) | |
| 207R00000X Internal Medicine (Licence: OR MD25034) | |
| 207R00000X Internal Medicine (Licence: AR E-1306) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2022-02-04 |