| NPI | 1922567247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP61513268) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR DO218795) |
| Enumeration Date | 2019-03-16 |
| Last Update Date | 2026-02-19 |