| NPI | 1659704963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A145405) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61000079) |
| 207R00000X Internal Medicine (Licence: NC 2019-00094) | |
| Enumeration Date | 2013-08-11 |
| Last Update Date | 2022-01-26 |