| NPI | 1154307742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA TD60506751) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 25226) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2014-09-15 |