| NPI | 1386630572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00047234) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: LA 14080R) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2021-11-29 |