| NPI | 1922072396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP00000836) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: WA OP0836) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2010-12-10 |