| NPI | 1790212496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA WDL78ZZBF93B) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 353446) |
| 208D00000X General Practice (Licence: MI 5101025360) | |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2025-10-07 |