| NPI | 1093129470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD183118) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60474275) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2020-10-05 |