| NPI | 1962608646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00049176) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: WA MD00049176) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: IA MD43877) | |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2024-01-31 |