| NPI | 1700987856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP00001982) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: WA OP00001982) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2023-04-25 |