| NPI | 1568783736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 12964) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA 60402282) |
| 207R00000X Internal Medicine (Licence: NV SL0728) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2021-10-11 |