| NPI | 1700994324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA WA MD00032225) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G 67900) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2007-07-08 |