| NPI | 1376592758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID O-216) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA OP00001634) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2016-03-08 |