| NPI | 1033603311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61081789) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-15717) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2024-04-26 |