| NPI | 1992864342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00040478) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID M-13065) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2026-06-03 |