| NPI | 1730316472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA WA60493815) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60493815) |
| Enumeration Date | 2009-06-21 |
| Last Update Date | 2021-06-03 |