| NPI | 1750640868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60970267) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A143158) |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2020-03-18 |