| NPI | 1730718628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00043351) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G42043) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2020-04-03 |