| NPI | 1427024843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00031189) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 31189) |
| Enumeration Date | 2006-02-25 |
| Last Update Date | 2014-05-05 |