| NPI | 1750455408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60035913) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 47475-20) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2014-06-06 |