| NPI | 1871088229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP61616183) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101024222) |
| 207R00000X Internal Medicine (Licence: OR DO211989) | |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2025-09-08 |