| NPI | 1629115225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: WA md000036572) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: WA MD00036572) |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: WA md000036572) | |
| 207RS0012X Internal Medicine, Sleep Medicine (Licence: WA md000036572) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2016-03-16 |