| NPI | 1225476625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61018208) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE NE 28245) |
| 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-51216) | |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2021-05-24 |