| NPI | 1821031725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD09293) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00014563) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2014-05-16 |