| NPI | 1588691521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP.60060138) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 4111) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2022-02-04 |