| NPI | 1053450627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: WA MD00047541) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00047541) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2012-03-07 |