| NPI | 1629285911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP60148816) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI L1125378) |
| 208D00000X General Practice (Licence: WA OP60148816) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2011-04-01 |