| NPI | 1215382098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60982817) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 3444) |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2021-08-17 |