| NPI | 1790993467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A92538) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00048336) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2021-12-02 |