| NPI | 1629340674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 60463721) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD176126) |
| 207R00000X Internal Medicine (Licence: CA A124966) | |
| Enumeration Date | 2012-02-07 |
| Last Update Date | 2020-05-15 |