| NPI | 1346216421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 60640294) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR 180693) |
| 207Q00000X Family Medicine (Licence: HI 22834) | |
| 207Q00000X Family Medicine (Licence: AL 11870) | |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2023-04-28 |