| NPI | 1801800404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00023191) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD00023191) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2021-04-27 |