| NPI | 1639194376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME 017333) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00045342) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2015-06-08 |