| NPI | 1063541100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: WA MD00033532) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00033532) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2012-01-13 |