| NPI | 1841487311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD27968) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60001658) |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2013-02-05 |