| NPI | 1568112597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID 4571360) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA DO70006050) |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2026-03-25 |