| NPI | 1871682237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00037171) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD16072) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2009-11-17 |