| NPI | 1396723466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60604626) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 5686) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2016-03-24 |