| NPI | 1184660235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 18524) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA 18524) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2011-07-22 |