| NPI | 1548503022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-0990) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60506022) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2024-12-26 |