| NPI | 1356720049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA op61443176) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102205469) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2024-08-14 |