| NPI | 1235469784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60463053) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 237030) |
| Enumeration Date | 2010-01-06 |
| Last Update Date | 2021-05-20 |