| NPI | 1518077437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M-10950) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60095563) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2014-01-23 |