| NPI | 1649263161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00020728) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-23943) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2024-07-22 |