| NPI | 1033465893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD. 208226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61378636) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2022-11-18 |