| NPI | 1952397440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL DO229) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA DO.OP.70062551) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2026-05-15 |