| NPI | 1437448453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 50762) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60394712) |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2024-05-24 |