| NPI | 1326121286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M4593) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00025241) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2016-03-08 |