| NPI | 1790288736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD199486) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA OP61426827) |
| Enumeration Date | 2018-03-15 |
| Last Update Date | 2026-03-18 |