| NPI | 1124298161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 00024572) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI MD-11129) |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2013-09-05 |