| NPI | 1184005332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR DO185061) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA OP61505037) |
| Enumeration Date | 2015-06-13 |
| Last Update Date | 2025-07-11 |