| NPI | 1437413556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WA OP60649784) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60649784) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2021-05-05 |