| NPI | 1477868685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60560172) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 336.094917) |
| 207R00000X Internal Medicine (Licence: IA 41018) | |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2015-09-02 |