| NPI | 1154583938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD70091509) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 17565) |
| 207R00000X Internal Medicine (Licence: CA C171926) | |
| 207R00000X Internal Medicine (Licence: HI 5560) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2026-08-05 |