| NPI | 1558855452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61194592) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116031965) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2024-03-28 |