| NPI | 1760639603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60078644) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 1038) |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2021-05-10 |