| NPI | 1811143365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00040446) |
| Additional Taxonomies | 207ZF0201X Pathology, Forensic Pathology (Licence: WA MD00040446) |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2010-11-01 |