| NPI | 1164873840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A157669) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61434850) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2023-07-25 |