| NPI | 1225284854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61310212) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD213100) |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2024-03-08 |