| NPI | 1538454723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD168979) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61253857) |
| 207R00000X Internal Medicine (Licence: OR PG155703) | |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2026-03-24 |