| NPI | 1497978563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60902996) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2014-02497) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2023-09-27 |