| NPI | 1952711152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60770576) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR PG178688) |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2026-04-23 |