| NPI | 1467993170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2024-00512) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA OL60751540) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2024-03-13 |