| NPI | 1558393207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60320097) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD15257) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2013-04-25 |