| NPI | 1861477093 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT 5277) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00024927) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2014-02-13 |