| NPI | 1548366891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 4934) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 44523) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2009-10-04 |