| NPI | 1013976653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA WA00016168) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 027317) |
| 207R00000X Internal Medicine (Licence: MA 221235) | |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2007-07-08 |