| NPI | 1063450765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00041912) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301078995) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2023-03-07 |