| NPI | 1528170750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8064719-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP00001998) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2012-10-16 |