| NPI | 1619066081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA MD60626598) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD24729) |
| 207Q00000X Family Medicine (Licence: WA MD60626598) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2016-02-26 |