| NPI | 1316999808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60496207) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 6440) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2022-12-05 |