| NPI | 1053306100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00046129) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 26688) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2021-03-19 |