| NPI | 1063941656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61171137) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OL60959551) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2022-06-23 |