| NPI | 1124213079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 52632) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60217840) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2021-03-15 |