| NPI | 1699810481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00017546) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: WA MD00017546) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2007-07-08 |