| NPI | 1184935090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60369048) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 60369048) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2021-06-08 |