| NPI | 1902842867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00018683) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 5713) |
| 207Q00000X Family Medicine (Licence: WA 00018683) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2008-08-01 |