| NPI | 1740265735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00043045) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00043045) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2011-11-03 |