| NPI | 1245214279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61603161) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA C175441) |
| 207R00000X Internal Medicine (Licence: FL ME91576) | |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2025-04-01 |