| NPI | 1720133887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 11478) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00044149) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2022-05-17 |