| NPI | 1952366734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 42791) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00044041) |
| 207Q00000X Family Medicine (Licence: CA A99572) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2010-08-20 |