| NPI | 1710975990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00042355) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-5176) |
| 207Q00000X Family Medicine (Licence: MT 7082) | |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2010-11-02 |