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 |