| NPI | 1720190978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60184475) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G20113) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-12-04 |