| NPI | 1649385212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00025464) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD14826) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2007-07-11 |