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 |