| NPI | 1114126562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 60280758) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 24329) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2020-10-02 |