| NPI | 1073596250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD15243) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00032858) |
| 207Q00000X Family Medicine (Licence: HI 15243) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2024-06-10 |