| NPI | 1174884688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60536801) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R2145) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2017-03-02 |