| NPI | 1588677942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD26183) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A53013) |
| 207R00000X Internal Medicine (Licence: WA MD60639219) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2026-02-12 |