| NPI | 1043502321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60803848) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101256407) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2021-01-18 |