| NPI | 1023022258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00017629) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA WA00017629) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2019-06-17 |