| NPI | 1427470483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 60731316) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18642) |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2022-07-21 |