| NPI | 1700413804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 99013) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61377941) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2024-03-14 |