| NPI | 1285049981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60792760) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101021364) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2021-04-19 |