| NPI | 1164659488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60949450) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R71541) |
| 208000000X Pediatrics (Licence: AZ R71541) | |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2019-07-23 |