| NPI | 1184940827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60485450) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD160522) |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2020-10-13 |