| NPI | 1518010941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00011083) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA AP2194986) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2008-05-13 |