| NPI | 1417536731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61661908) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD61661908) |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2025-09-23 |