| NPI | 1275897647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60557065) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301101062) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2021-11-22 |