| NPI | 1700950847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD208015) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61298850) |
| 207R00000X Internal Medicine (Licence: CA A74189) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2025-11-13 |