| NPI | 1386022507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61076565) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 100988) |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2021-12-20 |