| NPI | 1780741165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR OR MD13016) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00034575) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2016-04-13 |