| NPI | 1992805931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M-9924) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA ML20008230) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2014-01-23 |