| NPI | 1407907504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA MD00015352) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00015352) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2011-02-16 |