| NPI | 1285201186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61561024) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-10583) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2024-07-01 |