| NPI | 1861425316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: WA MD00026440) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00026440) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2013-08-26 |