| NPI | 1699335851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61325425) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116032847) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2022-08-12 |