| NPI | 1487037172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61120972) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL13715) |
| 207Q00000X Family Medicine (Licence: OR MD189039) | |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2021-05-11 |