| NPI | 1245241173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR md22783) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA md00033660) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2007-07-08 |