| NPI | 1356599054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60139994) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60139994) |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2018-05-24 |