| NPI | 1376572537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD18190) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00034569) |
| 207R00000X Internal Medicine (Licence: CA G46027) | |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2022-02-04 |