| NPI | 1104278829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.38544) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61545364) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2024-11-25 |