| NPI | 1699903559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61057968) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102202929) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2021-04-05 |