| NPI | 1508112418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 00015251) |
| Additional Taxonomies | 209800000X Legal Medicine (Licence: WA 00015251) |
| Enumeration Date | 2012-07-29 |
| Last Update Date | 2012-07-29 |