| NPI | 1861792335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD.60822396) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125058904) |
| Enumeration Date | 2010-10-29 |
| Last Update Date | 2024-08-28 |