| NPI | 1487876348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60145595) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301086713) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2015-02-13 |