| NPI | 1861016602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61415906) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-11928) |
| Enumeration Date | 2020-06-07 |
| Last Update Date | 2025-05-16 |