| NPI | 1316035355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00030759) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA md00030759) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2021-05-21 |