| NPI | 1831295401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 00019908) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: WA 00019908) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-07-11 |