| NPI | 1942232285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M-9259) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00034232) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2014-11-05 |