| NPI | 1033106554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60547095) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 23869) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2017-04-05 |