| NPI | 1750732418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60946168) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116029714) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2019-09-17 |