| NPI | 1023065539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00017877) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00017877) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2024-03-27 |