| NPI | 1629134077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00020772) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-8284) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2021-05-04 |