| NPI | 1033370739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD 60291304) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301092697) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2012-10-23 |