| NPI | 1750305660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 41439) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00045894) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2008-10-31 |