| NPI | 1629031950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61532255) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR e3472) |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2024-07-17 |