| NPI | 1629333471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60535103) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL12295) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2016-03-02 |