| NPI | 1295950962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD 60002369) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML20008584) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2014-03-06 |