| NPI | 1780843060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60284880) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 13462) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2012-11-15 |