| NPI | 1346253887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00023307) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD14724) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2008-11-06 |