| NPI | 1659507788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A94185) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD70065298) |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2026-01-06 |