| NPI | 1720577877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61276741) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 008157) |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2022-06-01 |