| NPI | 1407829435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00017439) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-10344) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2023-05-23 |