| NPI | 1669647830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 61259463) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR 152416) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2024-10-25 |