| NPI | 1891953766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60091337) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: WA MD60091337) |
| 208D00000X General Practice (Licence: WA MD60091337) | |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2011-03-23 |