| NPI | 1588869101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2007018075) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD600911409) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2024-11-19 |