| NPI | 1073856324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD197614) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60579470) |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2021-09-16 |