| NPI | 1598799777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00030693) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: WA MD00030693) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2010-01-13 |