| NPI | 1447272323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 5756670-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60136118) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2012-01-11 |