| NPI | 1225104235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD169232) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 5190415-1205) |
| 207Q00000X Family Medicine (Licence: WA MD00048052) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2014-11-03 |