| NPI | 1649634940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO211849) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OL60855318) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2023-02-10 |