| NPI | 1346702719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD70043230) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 390200000X) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2025-12-09 |