| NPI | 1912165226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60613516) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A109320) |
| 207R00000X Internal Medicine (Licence: OR MD151159) | |
| 207R00000X Internal Medicine (Licence: MA 246945) | |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2016-08-24 |