| NPI | 1417394156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60629781) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301103120) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2016-10-13 |