| NPI | 1699063016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60856427) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R72617) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2020-12-21 |