| NPI | 1346570728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: WA MD00034461) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: SD 8922) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: WA MD00034461) | |
| Enumeration Date | 2010-01-06 |
| Last Update Date | 2015-01-14 |