NPI | 1558433052 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP00001511) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 008315) |
Enumeration Date | 2006-11-14 |
Last Update Date | 2023-03-07 |