| NPI | 1043504863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60568396) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 9890752-1205) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2023-02-16 |