| NPI | 1578135885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61523479) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL17348) |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2024-07-16 |