| NPI | 1275793804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60222862) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MR-0981) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2022-06-28 |