| NPI | 1477181212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61439940) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A197476) |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2025-11-14 |