| NPI | 1255860086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61014528) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-09177) |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2020-07-20 |