| NPI | 1104866078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QB0002X Family Medicine, Bariatric Medicine (Licence: WA MD 60088504) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD16248) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2014-08-27 |