| NPI | 1962566745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00047850) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA ML20007988) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2010-11-08 |