| NPI | 1164803912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP61103535) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM A-2181-18) |
| 207R00000X Internal Medicine (Licence: MT 87955) | |
| 207R00000X Internal Medicine (Licence: ME DO2665) | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2023-03-09 |