| NPI | 1053772798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP60786444) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX 583153) |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2018-03-17 |