| NPI | 1144675133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 1199-320) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60866064) |
| Enumeration Date | 2016-04-27 |
| Last Update Date | 2021-05-18 |