| NPI | 1073661625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP00D00778) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID 028) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2010-11-30 |