| NPI | 1578530697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00037544) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 37544) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2012-11-26 |