NPI | 1730356858 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60106651) |
Additional Taxonomies | 208D00000X General Practice (Licence: WA MD60106651) |
Enumeration Date | 2008-05-08 |
Last Update Date | 2016-06-07 |