| NPI | 1609865377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G89407) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00030121) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2018-05-24 |