| NPI | 1306103338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR DO169455) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A23030) |
| 207R00000X Internal Medicine (Licence: WA 61611275) | |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2025-01-10 |