| NPI | 1952474009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA IMLC.MD.60902208) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR 190609) |
| 207R00000X Internal Medicine (Licence: IL 125-030506) | |
| 207R00000X Internal Medicine (Licence: WI 38324) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2025-08-01 |