| NPI | 1255326385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 107781) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60598761) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2016-11-02 |