| NPI | 1205035623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP00002267) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS9689) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2022-02-04 |