| NPI | 1518167543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60394340) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 4781) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2022-07-21 |