| NPI | 1649355462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD176531) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00028916) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2021-03-22 |