| NPI | 1073806865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60465597) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A120494) |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2014-07-31 |