| NPI | 1619050424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M4779) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00026059) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2016-01-18 |