| NPI | 1861591786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00036606) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD0036606) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: WA MD00036606) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2019-08-01 |