| NPI | 1366533481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00047202) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 48146) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2023-03-07 |