| NPI | 1912929928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M3622) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00014668) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2007-07-08 |