| NPI | 1023458676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61486367) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI DOS-2207) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2024-02-20 |