| NPI | 1689088999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A151353) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 260037) |
| 207R00000X Internal Medicine (Licence: WA MD60996831) | |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2025-08-05 |