| NPI | 1386081545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 298667) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60576872) |
| 207Q00000X Family Medicine (Licence: WA ML60382425) | |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2022-02-10 |