| NPI | 1528104742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 9166530) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00045528) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2016-10-16 |