| NPI | 1831167451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00029693) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 29693) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2020-07-31 |