| NPI | 1033268982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD26157) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60036057) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2023-07-31 |