| NPI | 1639197221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: WA MD00026093) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00026093) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2007-08-14 |