| NPI | 1811001381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A98794) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA ML20007987) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2021-12-15 |