| NPI | 1336172956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD20409) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00042108) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: OR MD20409) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: WA MD00042108) | |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2026-04-30 |