| NPI | 1932274347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA md00020891) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00010580) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2012-10-01 |