| NPI | 1760455745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60011510) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD600111510) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2020-12-09 |