| NPI | 1477550374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00040582) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00040582) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2015-10-07 |