| NPI | 1588036396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-14113) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00028532) |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2023-01-23 |