| NPI | 1265872956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 56639) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60928275) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2021-04-23 |