| NPI | 1134533144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60754043) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS13726) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2020-06-22 |