| NPI | 1073550323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 46597) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 33240) |
| 207Q00000X Family Medicine (Licence: OR MD27358) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2008-07-29 |