| NPI | 1225014640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00033703) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A48401) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2015-03-16 |