| NPI | 1568471621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61015612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME96512) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2024-12-27 |