| NPI | 1407964232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WA WA MD00034630) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR OR MD17558) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2007-07-08 |