| NPI | 1699888412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA md00022670) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR md12951) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2007-07-08 |