| NPI | 1467615930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID m-10849) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 60021448) |
| Enumeration Date | 2008-07-05 |
| Last Update Date | 2011-10-11 |