| NPI | 1184082091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61405961) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2020-00172) |
| 207Q00000X Family Medicine (Licence: NE 1678) | |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2024-01-04 |