NPI | 1477030880 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61245855) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL15209) |
Enumeration Date | 2018-07-27 |
Last Update Date | 2022-10-19 |