| NPI | 1841458973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD28592) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD 60018386) |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2025-08-06 |