| NPI | 1427066083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00029906) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 16492) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2020-05-12 |