| NPI | 1497791230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00023640) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA 23640) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2008-07-18 |