| NPI | 1154334670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WA MD60173758) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A48817) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2012-12-31 |