| NPI | 1093721508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60287379) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 054851) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2014-10-31 |