| NPI | 1568481547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00034014) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA 34014) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2020-10-23 |