| NPI | 1326200627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 8525148-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA 60256633) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2015-06-08 |