| NPI | 1114126760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA ML20008850) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD446446) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2022-03-25 |