NPI | 1255307047 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 390200000X) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60043267) |
Enumeration Date | 2006-02-23 |
Last Update Date | 2021-06-03 |