| NPI | 1053577379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 52713-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00048706) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2009-09-10 |