| NPI | 1518233055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP60558268) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR DO173762) |
| 207R00000X Internal Medicine (Licence: MT MED-PHYS-LIC-41922) | |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2023-12-07 |