| NPI | 1235392044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60041849) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A96348) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2012-09-12 |