| NPI | 1326269721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD27694) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60648472) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2025-12-17 |