| NPI | 1447757885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO197631) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 009205) |
| 207Q00000X Family Medicine (Licence: WA OP61031952) | |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2021-10-14 |