| NPI | 1073765400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A110041) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61143269) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2023-06-29 |