| NPI | 1104112051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD166885) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD166885) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2015-09-14 |