| NPI | 1154907806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP61666883) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR DO218931) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2025-03-12 |