| NPI | 1710970207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA MD00032279) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD32279) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2016-05-25 |