| NPI | 1265825236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 60549880) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 35835) |
| Enumeration Date | 2015-03-14 |
| Last Update Date | 2015-06-26 |