| NPI | 1033208848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD26343) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00038943) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2022-02-04 |