| NPI | 1487997169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61021807) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC MD37496) |
| 207Q00000X Family Medicine (Licence: NE 28217) | |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2021-10-06 |