| NPI | 1699738237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60220369) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A67685) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2022-05-31 |