| NPI | 1841224169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME107521) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00046655) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2016-01-07 |