| NPI | 1588662068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 61656) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00028579) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2021-12-07 |