| NPI | 1184812273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP60473472) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD H0069686) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2019-04-30 |