| NPI | 1770512014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00012865) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 30596) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2014-01-03 |