| NPI | 1205874955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: WA MD00014960) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00014960) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2015-04-06 |