| NPI | 1558353227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD 60137713) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK MD11783) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2010-12-01 |