| 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 |