| NPI | 1538358635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-10654) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00015580) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2011-06-29 |