| NPI | 1518209287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD215074) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 16511) |
| 207R00000X Internal Medicine (Licence: WA MD61414596) | |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2025-11-12 |