| NPI | 1447318274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME115126) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00025519) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2019-04-03 |