| NPI | 1659485613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00031355) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G73836) |
| 207R00000X Internal Medicine (Licence: OR MD154737) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2012-08-23 |