| NPI | 1528166394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00047328) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101041579) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2010-04-09 |