| NPI | 1669729414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A135869) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60976934) |
| Enumeration Date | 2012-08-11 |
| Last Update Date | 2024-11-05 |