| NPI | 1518548213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD220271) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61550815) |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2025-03-02 |