| NPI | 1346227170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00046741) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 5866640-1205) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2021-07-07 |