| NPI | 1699357152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61454902) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61454902) |
| 207R00000X Internal Medicine (Licence: AK 241024) | |
| Enumeration Date | 2021-04-24 |
| Last Update Date | 2025-10-27 |