| NPI | 1538502521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-57836) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60587849) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2022-09-12 |