| NPI | 1174651830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M-10887) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA md00044043) |
| 207R00000X Internal Medicine (Licence: MT 11190) | |
| 207R00000X Internal Medicine (Licence: ID M8854) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2022-05-05 |