| NPI | 1710307640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60759320) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A145246) |
| Enumeration Date | 2014-04-18 |
| Last Update Date | 2023-05-22 |