| NPI | 1902988546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301096051) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA ML20008767) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2010-05-13 |