| NPI | 1033441456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60532186) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME110919) |
| Enumeration Date | 2010-02-10 |
| Last Update Date | 2015-08-31 |