| NPI | 1164463378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60219921) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2006015797) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2011-06-28 |