| NPI | 1720263478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60004170) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM RS2005-0439) |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2021-04-28 |