| NPI | 1629335765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WA MD 00022108) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD 00022108) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2012-04-13 |