| NPI | 1720024490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60139996) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 37234) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2011-02-16 |