| NPI | 1235195017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60404371) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 31705) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2015-03-26 |