| NPI | 1184075988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 60943901) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA MD-44665) |
| 207Q00000X Family Medicine (Licence: IA R-10689) | |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2019-08-14 |