| NPI | 1528177151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-12761) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61233777) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2024-05-07 |