| NPI | 1477640910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00049223) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX H7264) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2009-07-08 |