| NPI | 1093965899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2013-02399) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60239356) |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2021-04-13 |