| NPI | 1316180037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61225125) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61225125) |
| 207R00000X Internal Medicine (Licence: MA 254635) | |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2022-07-18 |