| NPI | 1538254248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 19726) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA 19726) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2009-01-20 |