| NPI | 1154328052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-6680) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 32331) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2024-12-26 |