| NPI | 1356722003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 94-08688) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY TL4374) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2018-07-11 |