| NPI | 1306909676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD-15888) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00035371) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2021-08-25 |