| NPI | 1508191586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 4975) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60366898) |
| 208D00000X General Practice (Licence: WA OP60366898) | |
| Enumeration Date | 2009-10-09 |
| Last Update Date | 2023-11-13 |