| NPI | 1790740892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD21898) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX S8264) |
| 207R00000X Internal Medicine (Licence: WA MD60003713) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2026-07-15 |