| NPI | 1376983569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60968359) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD223407) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2025-02-11 |