| NPI | 1487628202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00033916) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD9651) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2010-10-18 |