| NPI | 1255355277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 52175) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00038880) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2019-08-12 |