| NPI | 1760461495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME117930) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00043754) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2021-12-10 |