| NPI | 1063470037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00049111) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 227104) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: WA MD00049111) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2021-05-24 |