| NPI | 1043207509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60467699) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 268705-1205) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2021-05-18 |