| NPI | 1851533913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60221519) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD155495) |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2015-04-09 |