| NPI | 1649289810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD 13391) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61116304) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2026-05-11 |