| NPI | 1538723291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61264179) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID M-17163) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2023-06-27 |