| NPI | 1710905112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: WA MD00018983) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00018983) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2010-05-20 |