| NPI | 1386039550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60840393) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD187602) |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2025-11-04 |