| NPI | 1033539275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60676862) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60471434) |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2022-07-21 |