| NPI | 1497049415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD192584) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60408685) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2024-01-25 |