| NPI | 1073544599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 13702) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00045037) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2016-02-05 |