| NPI | 1073883807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD 2444) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD 00004674) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2014-11-26 |