| NPI | 1376602276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME 018802) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME TD111009) |
| 207Q00000X Family Medicine (Licence: WA MD00033993) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2012-12-03 |