| NPI | 1508183948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60662849) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD166695) |
| Enumeration Date | 2010-04-26 |
| Last Update Date | 2020-11-24 |