| NPI | 1902190929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60408504) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60231303) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2013-12-30 |