| NPI | 1558309393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-1138) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 42482) |
| 207Q00000X Family Medicine (Licence: WA OP60271117) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2018-04-13 |