| NPI | 1376571083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00018335) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: WA MD00018335) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2020-03-10 |