| NPI | 1396800314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-8552) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00024771) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2008-05-19 |