NPI | 1467653766 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD188472) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00040616) |
Enumeration Date | 2007-05-31 |
Last Update Date | 2025-09-28 |