| NPI | 1356720676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60676925) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OL60563845) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2018-05-31 |