| NPI | 1124119730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 46667) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M5113) |
| 207Q00000X Family Medicine (Licence: WA MD00024276) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2009-06-02 |