| NPI | 1982792131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00012166) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00012166) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2021-06-02 |