| NPI | 1649618729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD215693) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA FK3034648) |
| 207Q00000X Family Medicine (Licence: VA 0101256995) | |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2023-07-24 |