| NPI | 1952358954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00019257) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: WA M100019537) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2013-07-19 |