| NPI | 1396799870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00046816) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 39682) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2012-04-17 |