| NPI | 1235173246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 027740) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00072474) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2008-06-11 |