| NPI | 1437115532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60076499) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 47105) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2010-02-09 |