| NPI | 1568467223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA 10276) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 10276) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2009-12-21 |