| NPI | 1154354371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00047393) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 55838771205) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2008-03-14 |