| NPI | 1891791232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00024849) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD188136) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2019-03-29 |