| NPI | 1619933934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: WA WA 00026409) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD 26409) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2021-05-25 |