| NPI | 1164629176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60074632) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD125848) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2011-06-28 |