| NPI | 1982683280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: WA 60327631) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI 4872) |
| 286500000X Military Hospital (Licence: WA 60327631) | |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2021-05-14 |