| NPI | 1679668594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 0018336) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA 000018336) |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: WA 000018336) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2023-01-12 |