| NPI | 1104181221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60409599) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OL60287940) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2014-08-26 |