| 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 |