| NPI | 1538217872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD20979) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA 34393) |
| 207R00000X Internal Medicine (Licence: HI MD-9554) | |
| 207R00000X Internal Medicine (Licence: NM MD2019-0627) | |
| 207R00000X Internal Medicine (Licence: CA G78781) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2020-03-25 |