| NPI | 1144221730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61251686) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ AZ28843) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2022-09-29 |