| NPI | 1316273279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042.0013288) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML 60107751) |
| Enumeration Date | 2009-10-28 |
| Last Update Date | 2015-10-09 |