| NPI | 1396718912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD26257) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60672191) |
| 207R00000X Internal Medicine (Licence: MA 216406) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2025-11-20 |