| NPI | 1669492419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00038611) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00038611) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2012-05-30 |