| NPI | 1154388759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME146890) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00049360) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2021-08-12 |