| NPI | 1245301241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00027092) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00027092) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2019-01-31 |