| NPI | 1285903419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 00017969) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 21005) |
| 207Q00000X Family Medicine (Licence: CA G86855) | |
| Enumeration Date | 2011-12-16 |
| Last Update Date | 2011-12-16 |