| NPI | 1699017376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 32469) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60736086) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2020-12-03 |