| NPI | 1396362034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61396490) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM RS2020-0616) |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2023-06-21 |