| NPI | 1417341686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD.MD.61545852) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 34099) |
| 207Q00000X Family Medicine (Licence: AR E-10683) | |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2024-05-22 |