| NPI | 1457779498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 201700719) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP61185758) |
| Enumeration Date | 2014-04-06 |
| Last Update Date | 2021-09-15 |