| NPI | 1285605451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61112177) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 40476-020) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2021-08-03 |