| NPI | 1578127502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61691530) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME MD25218) |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2026-01-07 |