| NPI | 1861804577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA op60778790) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ol60480696) |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2018-03-30 |