| NPI | 1578840880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00019977) |
| Additional Taxonomies | 207RH0003X Internal Medicine Hematology & Oncology (Licence: WA MD00019977) |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2011-11-15 |