| NPI | 1285079145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60646799) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 60646801) |
| 207Q00000X Family Medicine (Licence: TX Q2761) | |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2020-12-03 |