| NPI | 1144239435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD12335) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00016941) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2007-07-08 |