| NPI | 1316921455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60603289) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 39618) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2023-11-30 |