| NPI | 1326457904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60836207) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A145760) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2018-07-02 |