| NPI | 1508151689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60461203) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML 60222971) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2015-11-05 |