| NPI | 1659454528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD6045014) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2001-01597) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2014-07-22 |