| NPI | 1700373305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO218051) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP61139038) |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2024-02-02 |