| NPI | 1679004915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD193199) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61530844) |
| 207R00000X Internal Medicine (Licence: CA A172397) | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2024-07-02 |