| NPI | 1528086915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD206776) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 60068993) |
| 207Q00000X Family Medicine (Licence: LA 024466) | |
| 207Q00000X Family Medicine (Licence: MS 21791) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2021-10-20 |