NPI | 1760595664 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00028466) |
Additional Taxonomies | 174400000X Specialist (Licence: WA MD00028466) |
Enumeration Date | 2006-08-16 |
Last Update Date | 2024-04-23 |