| NPI | 1164561155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60145271) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 07R2006) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-12-03 |