| NPI | 1801822101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 25444) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00031454) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2011-06-27 |