| NPI | 1194815258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00022858) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G30535) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2012-04-04 |