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 |