| NPI | 1750720165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60596361) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL36009) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2022-02-14 |