| NPI | 1467446773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 11207) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP00002022) |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2023-10-27 |