| NPI | 1427469691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60752412) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-1400) |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2024-10-11 |