| NPI | 1114366143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA md60800332) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA mt203188) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2018-09-14 |