| NPI | 1669588828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR OR MD13983) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA WA MD00034553) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2015-08-08 |