| NPI | 1235332305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 48390-020) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 67328) |
| 207R00000X Internal Medicine (Licence: WA MD60449823) | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2023-12-28 |