| NPI | 1679576979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00032059) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00033285) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2019-08-22 |