| NPI | 1538267729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 48803) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 19481) |
| 207Q00000X Family Medicine (Licence: WI 45243) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2014-02-21 |