| NPI | 1629151428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP00001642) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID O221) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2021-04-28 |