| NPI | 1306106331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60464976) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60288578) |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2016-12-12 |