| NPI | 1093940116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60281989) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116021131) |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2021-04-22 |