| NPI | 1669476131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00035498) |
| Additional Taxonomies | 202K00000X Phlebology (Licence: WA MD00035498) |
| Enumeration Date | 2005-06-11 |
| Last Update Date | 2017-03-13 |