| NPI | 1861487084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60182108) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME0031957) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2011-01-19 |