| NPI | 1710940291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00030967) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: WA 30967) |
| 207R00000X Internal Medicine (Licence: WA MD00030967) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2010-06-10 |