| NPI | 1356305247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00034070) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD18973) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2012-09-29 |