| NPI | 1215170311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 9032A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60239556) |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2012-10-17 |