| NPI | 1063401347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00013980) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA MD00013980) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2021-09-24 |