| NPI | 1629569231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61079772) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60866504) |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2021-09-07 |