| NPI | 1063679587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A13891) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA OP61335231) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2022-08-11 |