| NPI | 1376921288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP60847673) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101021652) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2021-03-31 |