| NPI | 1578679858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA WA MD00041222) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR OR MD17810) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2007-07-10 |