| NPI | 1780889261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 49290) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60090627) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2014-09-18 |