| NPI | 1558320515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 6060) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 12441) |
| 207Q00000X Family Medicine (Licence: MN 32396) | |
| 207Q00000X Family Medicine (Licence: WA 60396764) | |
| 207Q00000X Family Medicine (Licence: CA 130997) | |
| 207Q00000X Family Medicine (Licence: OR 164791) | |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2015-10-08 |