| NPI | 1437115789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00044693) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 15612) |
| 207R00000X Internal Medicine (Licence: AK 5551) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2012-03-20 |