| NPI | 1659392090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60089222) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS6356) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2015-08-19 |