| NPI | 1457602773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 063148) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00045160) |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2012-09-26 |