| NPI | 1770681918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA md00028447) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR md17240) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-13 |