| NPI | 1841207206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR 17116) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA 28322) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2015-01-22 |