| NPI | 1043352206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60841405) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60841405) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2021-06-03 |