| NPI | 1164405387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: WA MD00024218) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00024218) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2016-06-17 |