| NPI | 1194733774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2013-01784) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00042734) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2014-02-10 |