| NPI | 1699792242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA 00048810) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2023-08-17 |