| NPI | 1649405226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60342809) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD60342809) |
| 208000000X Pediatrics (Licence: OK 27107) | |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2024-01-04 |