| NPI | 1134106867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60037715) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 41558) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2015-02-05 |