| NPI | 1285627547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00019031) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: WA MD00019031) |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: WA MD00019031) | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2014-05-12 |