| NPI | 1720430127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A166760) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61523860) |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2024-03-14 |