| NPI | 1649296971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00017298) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: WA MD00017298) |
| 207RH0003X Internal Medicine, Hematology & Oncology (Licence: WA MD00017298) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2010-10-15 |