| NPI | 1609978436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD12041) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00034522) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2007-07-15 |