| NPI | 1831584671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD186384) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60861210) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2026-07-14 |