| NPI | 1326431198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-1183) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OL60557910) |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2018-09-05 |