| NPI | 1346532215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME120137) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60529116) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2016-02-10 |