| NPI | 1194750117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60257750) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 35999) |
| 207Q00000X Family Medicine (Licence: MA 225114) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2022-07-21 |