| NPI | 1114941994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 43556) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 43566) |
| 207Q00000X Family Medicine (Licence: WA MD00035679) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2022-06-22 |