| NPI | 1578658936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 0044000) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: WA 0044000) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2014-10-14 |