| NPI | 1184967242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T8227) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102204002) |
| 207R00000X Internal Medicine (Licence: WA OP60926835) | |
| 208D00000X General Practice (Licence: WA OP60926835) | |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2025-09-05 |