| NPI | 1053517961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60147456) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME EC071017) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2024-04-22 |