NPI | 1083680201 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 1446) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP00001446) |
Enumeration Date | 2006-02-27 |
Last Update Date | 2021-03-01 |