| NPI | 1518970045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR OR MD14221) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA WA MD00032611) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2009-10-20 |