| NPI | 1457546590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60074654) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301091168) |
| 208000000X Pediatrics (Licence: MI 4301091168) | |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2017-01-04 |