| NPI | 1194987891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60250851) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 44160) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2021-12-17 |