| NPI | 1710967914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP1714) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI DOS-1207) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2017-05-12 |