| NPI | 1003349820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61164297) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME143491) |
| Enumeration Date | 2017-04-08 |
| Last Update Date | 2022-12-15 |