| NPI | 1407293202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60577168) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60375701) |
| 207Q00000X Family Medicine (Licence: TX T5668) | |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2022-03-09 |