| NPI | 1871145771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5315206795) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61252988) |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2025-05-22 |