| NPI | 1114133626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 243860) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60223570) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2011-11-08 |