| NPI | 1396739991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00047956) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 7446) |
| 207R00000X Internal Medicine (Licence: NH NH7446) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2014-12-25 |