| NPI | 1871288555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD.MD.70127414) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR PG215468) |
| 207R00000X Internal Medicine (Licence: OR PG226363) | |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2026-07-06 |