| NPI | 1114173440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0084572) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MC00048734) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2020-07-21 |