| NPI | 1447207584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 26477) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00046280) |
| 207Q00000X Family Medicine (Licence: OR MD27100) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2016-10-12 |