| NPI | 1538545892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61034484) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD P31348) |
| Enumeration Date | 2015-08-09 |
| Last Update Date | 2020-04-09 |