| NPI | 1629057658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60972406) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-24734) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2020-12-08 |