| NPI | 1316329782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61086585) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A145184) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2020-08-26 |