| NPI | 1043236052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00024619) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00024619) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2016-01-15 |