| NPI | 1306248018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61438502) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 074807) |
| 207Q00000X Family Medicine (Licence: KS 05-44815) | |
| Enumeration Date | 2014-09-24 |
| Last Update Date | 2023-10-26 |