| NPI | 1710091236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 7017) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME80508) |
| 207Q00000X Family Medicine (Licence: WA MD00029178) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2007-07-08 |