| NPI | 1023037009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00049361) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 35754) |
| 208D00000X General Practice (Licence: WA MD00049361) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2023-03-07 |