| NPI | 1871526186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60255737) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MR-0864) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2015-01-20 |