| NPI | 1003917600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00024401) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: WA MD00024401) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2012-11-09 |