| NPI | 1114985090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60147677) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 62022) |
| 207Q00000X Family Medicine (Licence: SC 14307) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2024-08-02 |