| NPI | 1376962753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 95559) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60729715) |
| 207R00000X Internal Medicine (Licence: OK 35512) | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2023-05-26 |