| NPI | 1679094239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61043198) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD225634) |
| Enumeration Date | 2017-07-04 |
| Last Update Date | 2025-09-21 |