| NPI | 1447755764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.016643) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OL61068377) |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2023-07-05 |