| NPI | 1508053174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60212129) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR LL16175) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2012-03-22 |