| NPI | 1255390621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 919) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP00000919) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2011-03-30 |