| NPI | 1902891518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M8556) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00041052) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2010-01-11 |