| NPI | 1407074479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301116551) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60178287) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-02-12 |