| NPI | 1063778793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD224259) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61661297) |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2025-08-12 |