| NPI | 1942378773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A116251) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00048708) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2015-04-07 |