| NPI | 1750339792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: WA MD00016693) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00016693) |
| 207V00000X Obstetrics & Gynecology (Licence: WA MD00016693) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2022-04-26 |