| NPI | 1538105465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME95334) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00043322) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2007-07-08 |