| NPI | 1033488077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60286888) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125055614) |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2022-10-21 |