| NPI | 1821035643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60576752) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI 11576) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2016-08-09 |