| NPI | 1265778849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP60475530) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A12576) |
| Enumeration Date | 2012-12-30 |
| Last Update Date | 2014-11-21 |