| NPI | 1174545917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 7324) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 60170584) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2022-01-06 |