| NPI | 1447472204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60291034) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301086527) |
| 207Q00000X Family Medicine (Licence: NY 003212-1) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2015-11-04 |