| NPI | 1427109321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M9844) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA MD00047236) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2008-05-14 |