| NPI | 1265495972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00041090) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 41741) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2018-04-11 |