| NPI | 1720051964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 89-198) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00034547) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2018-03-17 |