| NPI | 1548247315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61293488) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R3J59) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2024-02-06 |