| NPI | 1578781761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD152156) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA BF7751856) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2011-11-19 |