| NPI | 1679657977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 5433) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00042044) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2008-04-08 |